Coronary heart disease has been one of the leading causes of death in the U.S. and many developed countries. after the 1970s, many developing countries experienced rapid economic development and “westernization” of lifestyles, and the incidence of coronary heart disease rose sharply, and China is no exception. At present, there are more men than women suffering from coronary heart disease in China, more urban residents than rural residents, and more mental than physical workers in general, and the incidence is still gradually increasing and trending younger. How does coronary heart disease occur? How is it diagnosed? Who are more likely to suffer from coronary heart disease? How is coronary heart disease treated?
What is coronary heart disease? How does coronary heart disease occur?
When we talk about coronary heart disease, we have to mention the blood supply of the heart. The blood of human tissue is supplied by the heart, and the heart itself has an artery to supply blood, which is the coronary artery. The coronary arteries are divided into two branches, left and right, which travel on the surface of the heart and branch out into many smaller branches into the heart muscle. The fresh blood discharged from the ventricles first passes through the coronary arteries to meet the heart’s own needs for nutrients and oxygen, and then the blood is transported throughout the body.
Coronary artery disease is the occurrence of atherosclerotic stenosis or obstruction of the coronary arteries, or on top of that, combined with spasm or thrombosis, resulting in partial or complete blockage of the lumen, leading to insufficient coronary artery blood supply, myocardial ischemia and even myocardial necrosis. This series of lesions is collectively referred to as coronary artery disease.
The development of coronary heart disease is a complex and long process. It occurs overwhelmingly on the basis of coronary atherosclerosis. Atherosclerotic plaques cause narrowing of blood vessels, that is, narrowing of coronary arteries, and the narrowing of coronary arteries can bring about the following changes.
1. easy occurrence of coronary artery spasm, causing myocardial ischemia.
2, the occurrence of plaque instability, which leads to the formation of thrombus. After the formation of thrombus, if the vessel is completely blocked, it will lead to S-T segment elevation myocardial infarction; even if it is not completely blocked, it can lead to insufficient myocardial blood supply. Once the balance between the demand of oxygen for the heart and the blood supply of blood vessels for oxygen is broken, the myocardium will become ischemic and hypoxic, which leads to a series of symptoms such as chest tightness and pain.
3.When the stenosis reaches a certain degree, such as more than 70% or even 80% or more, the blood supply cannot meet the demand of the heart muscle when the human activity increases, which will also cause insufficient blood and oxygen supply to the heart.
In addition, when the capillaries of the heart become diseased and their function becomes impaired, it can also cause insufficient blood and oxygen supply to the heart. All of the above are pathological changes of coronary heart disease, and all of them are the reasons for the occurrence of coronary heart disease.
How to diagnose whether you have coronary heart disease? Or what are the main pathological changes of coronary heart disease?
Coronary heart disease is currently divided into two major categories, one is stable coronary heart disease and the other is acute coronary syndrome. Now there is another kind of coronary heart disease caused by capillaries, also called syndrome X. There is a difference between this X syndrome and the X syndrome caused by obesity metabolism.
Stable coronary heart disease tends to appear under conditions such as strenuous exercise, emotional excitement or after a meal, when myocardial oxygen consumption increases and coronary blood supply cannot meet the heart’s demand, causing a series of symptoms of myocardial ischemia. It should be noted that this heart discomfort is not always a pain in the heart, also called angina. Angina mainly manifests itself as a feeling of pressure and tightness in the precordial region, or even as palpitations, panic and chest tightness. This symptom usually lasts three to five minutes, rarely less than half a minute, and of course more than ten minutes is relatively rare, unless unstable angina or acute myocardial infarction.
Acute coronary syndrome is divided into two categories, namely unstable angina and myocardial infarction on electrocardiogram. Of these, myocardial infarction is subdivided into infarction with S-T segment elevation and infarction with non-S-T segment elevation. Acute coronary syndromes have a common pathological change, which is the formation of thrombus by platelet adhesion and aggregation based on the rupture of atherosclerotic plaque with surface erosion and erosion in the coronary arteries of the heart. Once a thrombus is formed, it causes a shortage of blood supply to the heart. If the blood vessel is blocked quickly, the myocardium will be completely deprived of blood supply, and necrosis will occur, which is commonly known as myocardial infarction; if the thrombus is blocked for a while and dissolves itself, it may produce non-S-T segment elevation myocardial infarction; if the blockage is mild, it may produce unstable angina pectoris. The diagnosis of myocardial infarction depends on the markers of injury released by myocardial necrosis, enzymes, and S-T segment elevation or depression on the ECG. The main difference between unstable angina and myocardial infarction is whether the markers of myocardial damage are elevated; we diagnose unstable angina if they are not elevated, and myocardial infarction if they are elevated. In myocardial infarction is also diagnosed as S-T segment elevation or non-S-T segment elevation myocardial infarction by the criterion of whether the S-T segment is elevated or not.
The current diagnosis is mainly divided into the following aspects.
1.To see whether there are typical symptoms, such as pressure and obstruction in the precordial area, obstruction in the throat, or radiation to the back, etc., and whether they last for three to five minutes or even more;
2, to see if there is evidence of coronary ischemia, including electrocardiogram ST-T changes;
3, to see if there is any relevant medical history, that is, the risk factors related to coronary heart disease, including smoking, obesity, male, family history, dislike of exercise, etc..
The combination of the above factors can basically make the corresponding diagnosis. In addition to the above methods, there are many techniques that can be applied to the diagnosis of coronary heart disease, such as coronary angiography, coronary CT, cardiac nuclear scan, exercise ECG, etc., which can be performed under the guidance of doctors.
We all know that the onset of coronary heart disease is related to various factors such as age, gender and genetics, but often these factors are not transferred by human will.
Apart from these unchangeable factors, there are many controllable factors for coronary heart disease, such as lipid abnormalities, hypertension, diabetes, hyperuricemia and other related diseases, which can easily lead to atherosclerosis and thus coronary heart disease, and the related indexes should be controlled within a reasonable range. Lifestyle is also a controllable factor, such as lack of exercise, overeating, fatty, sweet and thick food, barbecue and fried food, less vegetables and fruits, long-term high salt diet, smoking, etc. People with these bad habits also have a higher chance of coronary heart disease than normal people. In addition, mental unpromising, anxiety, depression, is also a risk factor for coronary heart disease. Therefore, it is very important to maintain optimism and good habits for people who have or have not suffered from coronary heart disease.
Cardiovascular disease has become the number one killer of human health, so people are very concerned about coronary heart disease and how it should be treated.
The treatment of coronary heart disease has made a lot of progress, and modern medical interventions are divided into two types, one is interventional therapy and the other is drug therapy. One kind of interventional treatment is coronary artery bypass, if the blood vessel is blocked, artificially place a normal blood vessel of itself, let it span the narrowed part, so that blood can pass smoothly; another kind is balloon dilation in the coronary artery, or put a stent on the balloon, with the support of imaging equipment, put the balloon into the narrowed part, then pressurize to make the narrowed part dilate, and then take out the balloon after the stent is placed, in order to prevent The stent is placed and then the balloon is removed to prevent the elasticity of the dilated vessel from retracting and forming a reobstruction.
The main pathological changes of coronary artery disease are abnormal lipid metabolism, platelet adhesion and aggregation, and thrombus formation, so improving lipid metabolism and anti-platelet adhesion and aggregation are the basic methods of drug treatment for coronary artery disease. In addition, beta-blockers such as western drugs betaloc and bisoprolol can reduce myocardial ischemic injury, and nitrate drugs such as cardiac pain and nitroglycerin can dilate coronary arteries and relieve cardiac ischemic symptoms in time. Of course, in addition to medication, attention should be paid to control the risk factors associated with coronary heart disease. The maintenance of good living habits and the control of related disease factors are the foundation, on this basis, the administration of drug therapy, such as anti-platelet adhesion aggregation, anti-thrombosis drugs, drugs to regulate myocardial metabolism, drugs to regulate lipid metabolism, etc., most of them can live happily with the disease, and even live a long life. Both healthy lifestyle and scientific and reasonable drug interventions are indispensable, and do not think that drug treatment can replace a healthy lifestyle. Due to the individual differences of different patients, not all patients can use the same class of drugs or the same dose of the same drug, which should be reasonably adjusted under the guidance of a specialist.
The adjustment of medication includes not only the western drugs mentioned earlier, but also Chinese medicine. The methods of clinical Chinese medicine application can be divided into two categories: one is tonics and the other is proprietary Chinese medicine. The individualization of tonics is more obvious, and the doctor can make adjustments at any time according to the changes of the patient’s yin and yang deficiency, which is more relevant to the condition and more in line with the concept of individualized treatment. Clinically, we have some patients who insist on taking traditional Chinese medicine and find that their prognosis is relatively optimistic.
At present, there are nearly 100 kinds of proprietary Chinese medicines for the treatment of coronary heart disease, and the mistake that patients tend to make in using them is not to identify the evidence and believe in the propaganda of TV, newspapers and even some folk news, which is a very serious misunderstanding. The indications of pCms are cold, heat, deficiency and reality, and different kinds of pCms correspond to different constitutions and different symptoms, which require doctors’ comprehensive judgment to determine the medication; another misconception is the superstitious belief in tonic and expensive medicines, such as ginseng, cordyceps, lingzhi, musk, artificial cowry, etc. In fact, many people are not suitable for tonic medicines. In fact, many people are not suitable for tonic, especially those patients who have the presence of evil real, but after tonic will have some adverse reactions. Although patients with deficiency can use tonic, the method of tonic should also be paid attention to, because there are different kinds of deficiency, including qi, blood, yin, yang, etc. For different kinds of deficiency, the method of supplementation and the drugs used are also different.
As far as the current medical level is concerned, it is impossible to completely cure coronary heart disease. Therefore, do not believe in irresponsible media propaganda, and do not believe in advertisements that pursue commercial interests against your conscience, and do not take tonic drugs blindly. If you develop and adhere to good habits, take the right medication for your condition under the guidance of your doctor, and live in harmony with your disease with optimism, living longer with your disease is not just a dream.